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Comparative efficacy of exercise and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: A network meta-analysis.

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posted on 05.02.2021, 09:34 by Chris Noone, Joy Leahy, Eimear Morrissey, John Newell, Micheal Newell, Christopher P. Dwyer, Jane Murphy, Frank Doyle, Andrew W. Murphy, Gerard J. Molloy

Aims: This analysis aims to estimate the comparative efficacy of anti-hypertensive medications and exercise interventions on systolic and diastolic blood pressure reduction in people with hypertension.

Methods: A systematic review was conducted focusing on randomised controlled trials (RCTs) of exercise interventions and first-line anti-hypertensives where blood pressure reduction was the primary outcome in those with hypertension. Network meta-analyses were conducted to generate estimates of comparative efficacy.

Results: We identified 93 RCTs (N = 32,404, mean age in RCTs: 39-70 years) which compared placebo or usual care with first-line antihypertensives including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazide-like diuretics and exercise interventions including aerobic training and dynamic resistance training. Of these, there were 81 (87%) trials related to medications (n = 31,347, 97%) and 12 (13%) trials related to exercise (n = 1057, 3%). The point estimates suggested that antihypertensive medications were more effective than exercise but there was insufficient evidence to suggest that first-line medications significantly reduced blood pressure to a greater extent than did the exercise interventions. Of the first-line treatments, angiotensin receptor blockers and calcium channel blockers had the highest treatment ranking, while exercise had the second lowest treatment ranking, followed by control conditions.

Conclusion: The current evidence base with a bias towards medication research may partly explain the circumspection around the efficacy of exercise in guidelines and practice. Clinicians may justifiably consider exercise for low risk hypertension patients who confirm a preference for such an approach.

Funding

Irish Research Council under the New Horizons grant scheme [REPRO/2016/31].

History

Comments

Copyright: © European Society of Cardiology

Published Citation

Noone C, Leahy J, Morrissey EC, Newell J, Newell M, Dwyer CP, Murphy J, Doyle F, Murphy AW, Molloy GJ. Comparative efficacy of exercise and anti-hypertensive pharmacological interventions in reducing blood pressure in people with hypertension: A network meta-analysis. European Journal of Preventive Cardiology. 2020;27(3):247-255.

Publication Date

15 October 2019

PubMed ID

31615283

Department/Unit

  • Health Psychology

Research Area

  • Population Health and Health Services

Publisher

Sage Publications

Version

  • Accepted Version (Postprint)